“Osteoporosis” Drug Maker Diagnosis or Treatable Disease?

This blog post is for my patients I see every week that are told they need to go on a bisphosphonates drug (Fosamax, Boniva, Reclast) because of low bone density. Our bones are constantly remodeling, however, this remodeling slows down as we age. There are two main types of cells at work in bone remodeling: osteoclasts that break down bone, and osteoblasts that lay down new bone.

Brittle Bones

The bisphosphonates suppresses the osteoclasts activity thereby increasing bone density on a scan. However what that leaves you with are bones filled with old cells. e.g. Brittle bones! Fractures at an older age is nothing new as Chinese medicine wrote 2000 years ago diseases of the bone. In addition, there are many case studies over the past 2 millennia showing the use of Chinese medicine for broken bones. Plus we know that lifestyle and diet can play a role in a reduction of bone fractures.

Look At The Patient Presentation

Western medicine focuses on the tree and misses seeing the forest. The tree, in this case, is the use of drugs to increase bone density (albeit dense brittle bones). The forest treatment would be addressing endocrine system imbalance or low hormone levels; Reducing exposure to organophosphates and changing diet habits; proper exercise and sleep. However, these changes need to start early in life as the improvements can take time. Certainly, there is a small specific subgroup of the population where a bisphosphonate drug can reduce fracture but this subgroup is significantly smaller than what is being treated. Western medicine needs to look at the patient (are they thin? history of fracture? active lifestyle?) rather than just looking at a DEXA scan result.

I know many doctors are certainly doing what they can in terms of lifestyle interventions for their older patients. Insurance does not allow them sufficient time to do what they would like. However from what I hear from my patients, many are too quick to start people on medication.

References

1.

Järvinen TL1, Michaëlsson K2, Aspenberg P3, Sievänen H4. Osteoporosis: the emperor has no clothes. J Intern Med. 2015 Jun;277(6):662-73. PMID: 25809279. [PubMed] [Read by QxMD] Current prevention strategies for low-trauma fractures amongst older persons depend on the notions that fractures are mainly caused by osteoporosis (pathophysiology), that patients at high risk can be identified (screening) and that the risk is amenable to bone-targeted pharmacotherapy (treatment). However, all these three notions can be disputed. […]